Healthcare Provider Details

I. General information

NPI: 1790891844
Provider Name (Legal Business Name): SYLVIA M ANDERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SYLVIA M BARNES

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 OAK STREET
FAULKTON SD
57438-0100
US

IV. Provider business mailing address

1300 OAK STREET
FAULKTON SD
57438-0100
US

V. Phone/Fax

Practice location:
  • Phone: 605-598-6262
  • Fax: 605-598-4199
Mailing address:
  • Phone: 605-598-6262
  • Fax: 605-598-4199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5882
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: